TREATING SEPSIS

Step G:  Feed the Gut

• Prevention of gut mucosal villous atrophy and bacterial translocation involves restoration of splanchnic blood flow and of gut luminal nutrition.

There has been extensive discussion on the effects of vasoactive drugs on intestinal blood flow. The lining of the gut requires oxygen, from the blood, and nutrients, from the gut lumen, to stay intact. The presence of this lining is important as a barrier to bacterial translocation (1). Early enteral nutrition maintains it. Thus an “inside-outside” gut protection strategy has emerged: combining splanchnic vasodilators, such as dobutamine, with feeding. Immunonutrition (2) is an advanced enteral strategy that combines glutamine, omega-3 fatty acids, arginine and ribonucleotides and conventional feeding substances. There is some evidence that these formulas reduce the risk of infection (3).

References

(1)   MacFie J. Enteral versus parenteral nutrition. Br J Surg 2000; 87(9):1121-1122.

(2)   Beale RJ, Bryg DJ, Bihari DJ. Immunonutrition in the critically ill: a systematic review of clinical outcome. Crit Care Med 1999; 27(12):2799-2805.

(3)   Barbul A. Immunonutrition comes of age. Crit Care Med 2000; 28(3):884-885.

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